Individual provider Active NPI

Ayodeji E Okorafor, PMHNP

  • Psychiatric/Mental Health Nurse Practitioner
  • Sturbridge, MA
National Provider Identifier
1871091371
Registry record updated Mar 11, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X
License
RN2281539 Issued in MA
Practice address
58 Main St Ste 3
Sturbridge, MA 01566-1507
Phone
(781) 222-3979
NPI assigned
Jan 30, 2018
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Mar 11, 2024

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychiatric/Mental Health Registered NurseGroup: 193400000X SINGLE SPECIALTY GROUP 163WP0808X RN2281539 MA
Psychiatric/Mental Health Nurse Practitioner 363LP0808X RN2281539 MA Primary

Addresses

Primary practice location

58 Main St Ste 3
Sturbridge, MA 01566-1507

Mailing address

15 Stanley Ave
Taunton, MA 02780-3014
Phone (617) 291-3744

Other identifiers 1

IdentifierTypeStateIssuer
S35673590MedicaidMA

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20190131001327 MA Practitioner - Nurse Practitioner 1153668967 Reassigns benefits to 3 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices
T Massachusetts, LLCGroup PAC ID 6901159003, 20 clinicians

Practice addresses (Care Compare)

100 Century Dr
Worcester, MA 01606-1244
Phone (884) 319-0000

300 Friberg Pkwy
Westborough, MA 01581-3900
Phone (508) 329-6300

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Supportive Behavioral Care of Ma LLC Single Specialty CurrentSince Aug 15, 2024 Accepting new patients
Westborough Behavioral Healthcare Hospital, LLC Single Specialty CurrentSince Dec 28, 2022 Accepting new patients
High Point Treatment Center Inc. Past Accepting new patients

Locations

44 School St
Rm 325
Boston, MA 02108
Phone (508) 831-8558

300 Friberg Pkwy
Westborough, MA 01581
Phone (508) 329-6158

27 Randolph Rd
Howell, NJ 07731
Phone (972) 677-7951

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1517270400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1710115200000",
    "number": "1871091371",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "15 STANLEY AVE",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "027803014",
            "telephone_number": "617-291-3744"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "58 MAIN ST STE 3",
            "city": "STURBRIDGE",
            "state": "MA",
            "postal_code": "015661507",
            "telephone_number": "781-222-3979"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "OKORAFOR",
        "first_name": "AYODEJI",
        "middle_name": "E",
        "credential": "PMHNP",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2018-01-30",
        "last_updated": "2024-03-11",
        "certification_date": "2024-03-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "163WP0808X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Registered Nurse, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2281539",
            "primary": false
        },
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "MA",
            "license": "RN2281539",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "S35673590",
            "state": "MA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Sturbridge, MA

Sources for this page

Verify at the official NPI Registry.